This is the first in a two-part series on a remarkable event that took place in Zürich, Switzerland, in June 2018. It is a review of a conference that will hopefully help to change conventional medical treatment for obesity and type 2 diabetes dramatically in the near future.

Speakers came from top research institutions around the globe. They argued that mainstream medical treatment for type 2 diabetes just doesn’t work well. In effect, it keeps people fat, sick and dependent on drugs.

That was fighting talk from physicians and scientists from around the globe. Their alternative was just as groundbreaking: It gives people with type 2 diabetes hope that they can reverse their condition safely and effectively without resorting to drugs or surgery.

(This is a longer version of a report that first appeared in Business Day newspaper in South Africa.)

By Marika Sboros

You know something big is happening when the world’s second-largest reinsurer, Swiss Re, has its eye on the future of diabetes treatment. And when the reinsurer hosts a global four-day conference casting serious doubt on mainstream medical treatment for type 2 diabetes.

Messages emanating from the conference were groundbreaking – and optimistic. Speakers said that type 2 diabetes is not necessarily chronic, progressive and degenerative. It can be reversed, even put into remission.

Speakers also said that low-carbohydrate, high-fat (LCHF) diets are safe, effective methods of reversing. And that patients don’t always have to resort to drugs or invasive bariatric (stomach) surgery.

Radical revision needed

Dr John Schoonbee. Picture: David Ausserhofer

Also under the spotlight at the conference were official low-fat, high-carb dietary guidelines. Speakers targeted the guidelines as major contributors to global epidemics of obesity and type 2 diabetes (or “diabesity” as doctors now call the twin incidence). They also called for radical revision of the guidelines.

It doesn’t take a rocket nutrition scientist to work out what is in it for the company to drive dietary change. Nor is it difficult to identify the main driver in this case: Swiss Re’s global chief medical officer, South African Dr John Schoonbee.

The reason for the reinsurer’s interest in nutrition is simple, Schoonbee said: “If more people die, we pay out more. If fewer people die, we pay out less. So, we want to keep people living longer, healthier lives.”

The cost of disease

Non-communicable diseases (NCDs) now account for six of the top seven causes of death globally, he said. Obesity, prediabetes and diabetes are growing global epidemics strongly associated with heart disease, stroke, cancer and Alzheimer’s disease.

Diet is the key factor in obesity and diabetes. Fixing nutrition won’t just slow down these epidemics but can also reverse these conditions, Schoonbee said.

As a large global reinsurer in life and health, Swiss Re’s exposure to long-term mortality and morbidity is “significant”. Improving these will lead to “very significant financial benefit”. It will also create an advantage allowing it to win new business.

The company’s vested financial interest “entirely aligns with (its vision of) making the world a healthier, more resilient place”, he said. Therefore, its research arm, the Swiss Re Institute, regularly engages with stakeholders. It does so by “sharing insights, tailored services and products to enable risk-focused decision making and smarter solutions to manage risk”.

Conference delegates included nutrition scientists, endocrinologists, cardiologists, epidemiologists, psychiatrists and a South African, UK-based plastic surgeon. And among top research institutions represented were Harvard and Tufts universities in the US, Cambridge University in the UK and Sydney University in Australia.

Miracle meeting

The first two days debated Food for Thought, Science and Politics of Nutrition. That was a collaboration between the Swiss Re Institute and The BMJ (formerly The British Medical Journal) to launch a series of articles under the same name. These were researched and written by nutrition experts and advised by Cambridge University and Tufts University.

Dr Fiona Godlee

BMJ editor-in-chief Dr Fiona Godlee opened by saying: “There is no miracle diet but there is a miracle meeting and this is it.”

The meeting was not exactly miraculous. However, it did bring together on one stage for the first time experts with divergent views on optimum nutrition to treat and prevent obesity and diabetes.

An echo chamber it wasn’t.

Speakers raised one of the biggest scandals and controversies in nutrition science. It is that the guidelines had no science backing them up when the US first launched them onto an unsuspecting public way back in 1977. The same applied when the UK followed in 1983 and the rest of the English-speaking world thereafter.

Among speakers who have done major research on this topic were US science journalist Nina Teicholz, author of The Big Fat Surprise and British public health researcher DrZoë Harcombe. Harcombe is author of, among others,The Obesity Epidemic, What Caused It? How can we stop it?

Plant v animal

Some speakers vigorously promoted plant-based diets as optimum to treat and reverse diabesity. Among them was Prof Walter Willett, professor of epidemiology and nutrition at Harvard TH Chan School of Public Health. Willett is also professor of medicine at Harvard Medical School.

UK professor of medicine and metabolism Roy Taylor sat somewhere in the middle. Taylor, of Newcastle University, has spent more than 40 years studying type 2 diabetes and best treatment methods.

He said that eating patterns vary in different populations and there’s no one-size-fits-all diet. He also said that LCHF diets are “reasonable” treatment for type 2 diabetes. That’s provided they are “not extreme”.

Taylor agreed that diabetes is reversible. However, one obstacle is doctors who are “highly trained in using drugs and hardly at all in nutrition”.

Flawed science

British consultant cardiologist Dr Aseem Malhotra, author of The Pioppi Diet, came down firmly on the side of animal foods. He said that the huge global burden of chronic disease shows that doctors and healthcare systems have failed patients.

Commercial interests have hijacked the best available clinical evidence. And the root cause of obesity and type 2 diabetes is “flawed science”, Malhotra said.

There was consensus that dietary guidelines have contributed to the global diabesity tide. There was also consensus that LCHF diets can stem it.

US physician Dr Sarah Hallberg is adjunct clinical assistant professor of medicine at Indiana University Medical School and medical director at Virta Health. Analysts have called Virta one of San Francisco’s “hottest startups”. The company recently announced that it had raised $45m funding, bringing the total equity funding to $75m to date.

Hallberg said that diabetes is a disease of elevated blood sugar and even the American Diabetes Association acknowledges that carbohydrate is the macronutrient that aggravates it. She also said that there is no one-size-fits-all approach.

Healthy people can tolerate plant-based diets, Hallberg said. However, once they enter the disease state or have metabolic issues, then the evidence shows that animal-based diets are healthier.

Patient choice

Hallberg welcomed financial institutions showing interest in nutrition. Healthcare and related costs for type 2 diabetes are staggering, she said. In the US, it costs well over $10,000 a year to treat diabetic patients and costs are growing.

Hallberg is lead author of a Virta peer-reviewed study recently published in Diabetes Review. Results are from the first 12 months of the five-year study investigating standard- of-care, low-fat and low-carb therapies.

Dr Sarah Hallberg

Among key takeaways, she said, data show for the first time that reversal is possible in a large-scale trial and in more than just anecdote. Data also show high adherence to LCHF diets.

Doctors often cite adherence as a barrier to nutrition for effective type 2 diabetes reversal, Hallberg said. However, at the end of a study year, 83% of patients on LCHF were still actively engaged.

“That’s better adherence than with most medications,” she said. Hallberg attributed that to a study design allowing patients to self-select from three diet arms.

She said that patient choice “is key” in diabetes treatment.

Virta data show that LCHF can achieve improvements in cardiovascular disease risk factors at the same time as diabetes reversal, Hallberg said. The LCHF group showed a significant 40% decrease in inflammation, a key cardiovascular disease risk marker.

‘No-brainer’

Low-density lipoprotein (LDL, so-called “bad” cholesterol) went up by 10%. Other markers that are better risk indicators, such as LDL B and apolipoprotein (APO) B, did not change.

Resistance to LCHF is because many doctors are still “scared of (saturated) fat”. The saturated fat debate is “over”. We are pretty much done with it and we now need to get that message across, Hallberg said.

Malhotra referred to a seminal article he wrote in the BMJ in 2013, titled Saturated fat is not the issue. In it, he said that it has become a “mantra” that people must eat less saturated fat because it causes heart disease. Scientific evidence shows that this advice has” paradoxically increased our cardiovascular risks”, Malhotra said. Therefore, it is time to retire the mantra.

He went on to target the UK government’s “obsession with levels of total cholesterol”. He said that this has “diverted our attention from the more egregious risk factor of atherogenic dyslipidaemia”. It has also led to the “overmedication of millions of people with statins”.

Treatment ‘a lottery’

UK diabetologist Dr David Cavan, who calls himself a recovering endocrinologist, described modern medical management of type 2 diabetes as “a lottery” and “scandalous”.

Cavan is author of Reverse Your Diabetes, The Step By Step Plan To Take Control Of Type 2 Diabetes.

In 2013, he became director of policy and programmes at the Brussels-based International Diabetes Federation, a global federation representing over 230 national diabetes associations. In 2017, he set up a Diabetes Reversal Programme in Bermuda, in association with Bermuda Diabetes.

“Bermuda is a diabetes factory,” Cavan said.

Its “diabetogenic” environment ticks all the boxes for increased risk of type 2 diabetes. These include a staple diet of starch (rice and peas), high intake of sugary soft drinks, easy availability of low-cost, junk food and the high cost of healthy foods.

Of 30 participants on his LCHF programme after the first 12 months, all but four lost weight and waist circumference. Eight stopped all diabetes medications and 11 reduced some diabetes medication.

Cavan said it is now clear that type 2 diabetes results from modern lifestyles. This has led to the evolution of a new management paradigm.

‘Unbiased debate’

He outlined the basic principles: type 2 diabetes is associated with insulin resistance or carbohydrate intolerance; it can be reversed and remission is the goal; carbohydrate restriction is vital; intermittent fasting, low-carb and ketogenic (very-LCHF) diets work.

Jeffrey Bohn, Swiss Re Institute director, said that the BMJ partnership reflects a focus on major research topics for the future of the insurance industry and wider society.

“Swiss Re Institute has established itself as a platform for unbiased debate. I was particularly pleased that the Food for Thought conference was live-streamed and viewed more than 5,700 times by people in 63 countries,” Bohn said.

Schoonbee said that Swiss Re is agnostic.

“We don’t endorse any one diet. We want to know what works and we accept it as long as it is evidence-based. In that way, we are truly unbiased.”

He ended with a rallying call: “Imagine if we could stop diabetes and obesity epidemics and change the trajectory for world health, and for policy makers.”